Form Ds 621 PDF Details

Navigating the intricacies of retirement account distributions can be a complex process, underpinned by the need to understand various forms and regulations to ensure compliance and make informed decisions. The DS-621 form serves a pivotal role for individuals aiming to manage distributions from their Individual Retirement Accounts (IRAs). Essential for initiating distributions, this form covers a broad spectrum of choices including the type of IRA plan such as Traditional, Roth, SEP, or SIMPLE IRAs, and the reasons for the distribution which range from regular, mandatory after reaching certain ages, premature with possible exemptions from penalties, to scenarios involving death. Additionally, the form provides options for the method and frequency of distributions, be it as a lump sum, in installments, or through specific payout strategies. Importantly, it touches on the federal income tax withholding election, offering individuals the choice to have taxes withheld from their distributions to meet federal tax obligations. The authorization section at the end of the form confirms the request for the distribution under agreed terms, highlighting the importance of accuracy and thoroughness when completing this document. Ensuring a clear understanding of each section of the DS-621 form is crucial for individuals to manage their retirement savings effectively and align their withdrawal strategy with their financial goals and tax planning.

Form NameForm Ds 621
Form Length3 pages
Fillable fields0
Avg. time to fill out45 sec
Other namesrecipients, Revocation, Deferred, RMD

Form Preview Example


Please complete all pertinent informationrequested below:


















Date of Birth:


























































Regular Distribution (after age 59 ½)

















Mandatory Distribution (“RMD”) (after age 72 starting 01/01/2020)

Premature Distribution (before age 59 ½):





possible IRS penalty


exempt from IRS penalty



Internal Transfer












Excess Contribution


current year


prior year












(e.g., Conversion to Roth Revocation, Recharacterization, etc.)

Death (complete Section 4: additional documentation required.)


Receipt* of funds:


Designated IRA beneficiary

Legal representative

*Verification of identify is required








Date of Birth:




























































(W) or (C)


Required Minimum Distribution (RMD)*












Close Account (s)



Pay in installations based on Uniform Lifetime Table








Specified Amount(s)



Pay in installments based on Joint Life and Last Survivor Expectancy Table








Pay in installments based on Single Life Expectancy for deaths on or prior to


Interest only – Installment Payments

to 12/31/2019 and for certain other beneficiaries (including to Estates,









Organizations, etc.)





















*RMDs are not required for ROTH IRAs during the participant’s lifetime









Pay in installments based on a Ten-Year Payout for deaths on or after 01/01/2020









Pay in installments a flat amount of $





(greater than RMD)









Pay in installments over a Five-Year Payout if deceased under 72 at the time of









death (for non-entities – Estate, Organization, Charity, Certain Trusts)



At Maturity INSTALLMENTS: Monthly





Please indicate the month in which distributions should start

Deferred Distribution: If you reach age 72 this year, you may elect to defer this year’s distribution up to April 1st of the following tax year. You are allowed to defer this distribution only for the year that you reach age 72. If you defer your distribution until next year, two withdrawals will be made in the same year. Please indicate which month you would like your deferreddistribution:

January February March

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Federal Income Tax Withholding Election: You must select one, withholding options as noted below. If you do not we are required to automatically withhold from your taxable payments as required by Federal Law.


Do not withhold federal income tax from payments

I elect to have the amount of $


withheld from my distribution





payment(s) (not available for automatic distribution)


Withhold federal income tax from payments (10% - normal)


other percentage



Method of Payment










Automated Clearing House (“ACH”) Entry










Check mailed to the recipient’s address


Check mailed to recipient of funds in Section 4


EFT deposit to IRA owner’s Apple Bank Account:










Savings: Checking: NOW: or Money Market Account No.










Specify Dollar ($) Amount(s):

Specify affected retirement account(s): list numbers below

















































Please note that early withdrawals from time deposit accounts may result in interest penalties. See your accountdisclosures.

IF YOU HAVE SELECTED ACH ENTRY as your method of paymenti:

(A)Your Financial Institution must be an ACH Participant (acting as the RDFI); and

(B)A VOIDED check or pre-printed deposit ticket marked VOID must be attached with this authorization form.

Additionally, please provide the following Third Party Financial Institution information:





















(“RDFI”) Address:

























Routing Transit/ABA Number:










Account Number:


































Type of Account:























Checking Account

Savings Account


By signing this authorization, below:

You authorize us, as Trustee, to make a withdrawal(s) from the IRA account(s) identified above in the manner and for the reason(s) indicated. You affirm that the withdrawal(s) are permitted under the terms and conditions of the applicable Traditional, Roth, SEP or SIMPLE IRA Adoption Agreements that you have signed and meet all legal requirements of the Internal Revenue Code (“IRC”). Apple Bank may rely on your statements herein and shall not be held liable for any tax, penalty or other consequence incurred in connection with any withdrawal hereby authorized.

You represent and warrant that the referenced Third Party Financial Institution (“Third Party FI”) account(s) to which you have directed your distribution(s) is/are held in your name.

You acknowledge that withdrawals from a non-Roth IRA will be taxed as ordinary income and may be subject to a 10% early withdrawal penalty if taken before age59½.

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You recognize that withdrawals made from any SIMPLE IRA prior to age 59½ and within the first two years of participating in an employer’s SIMPLE IRA plan may be subject to a 25% early withdrawal penalty.

You shall Indemnify Apple Bank from any liability in the event that you fail to meet any applicable IRS requirements.

You certify under penalties of perjury that you are a U.S. citizen or other U.S. person (including a resident alien individual) and that the tax identification number shown (TIN) on this form is your correct TIN.

Customers selecting ACH Entries:

Authorize and request Apple Bank to make direct transfer EFT distributions from the Apple Bank IRA listed in this form by initiating debit entries to such Apple BankIRA.

Authorize us, upon receiving instructions from you or as otherwise authorized by you, to make payments from you and to you, by credit entries to the designated account at the Third Party Financial Institution identified above (the “Third Party FI”). You authorize the Third Party FI to process such entries and to credit the designated account(s) for such entries. You ratify such instructions and agree that neither we nor any mutual fund will be liable for any loss, liability, cost, or expense for acting upon all such instructions believed to be genuine if we employ reasonable procedures to prevent unauthorized transactions. You agree that this authorization may only be revoked by written notice to us in such time and manner as to afford us and the Bank a reasonable opportunity to act uponit.

Warrant and represent that (i) the third party’s account identified in Section 3 is owned by a natural person, (ii) that person has authorized his/her account to be credited in accordance with your instructions, and (iii) the account has been established for personal, family, or household use, and not for commercial purposes.

Name of individual receiving funds (please print)




Authorized Signature







Print Name

Teller Number

iIf your ACH or EFT deposit cannot be originated or processed for any reason a check will be mailed to the record address until such time a new designation is presented.

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How to Edit Form Ds 621 Online for Free

It is really an easy task to fill out the disclosures empty lines. Our PDF editor will make it virtually effortless to fill in any sort of PDF. Below are the primary four steps you need to take:

Step 1: Pick the button "Get Form Here".

Step 2: At this point, you are able to update the disclosures. This multifunctional toolbar lets you add, erase, change, highlight, and conduct other sorts of commands to the content and areas within the file.

Enter the requested information in every area to fill in the PDF disclosures

example of blanks in 2006

Indicate the information in DISTRIBUTION DUE TO DEATH, Receipt of funds, Designated IRA beneficiary, Legal representative, Verification of identify is, Name, Address, Date of Birth, SSN, Phone, W or C, DISTRIBUTION INSTRUCTIONS, Required Minimum Distribution RMD, Close Account s, and Specified Amounts.

Entering details in 2006 stage 2

Indicate the main details in field.

Filling in 2006 part 3

The Federal Income Tax Withholding, Do not withhold federal income tax, I elect to have the amount of, Withhold federal income tax from, other percentage, payments not available for, Method of Payment, Automated Clearing House ACH Entry, Check mailed to the recipients, Check mailed to recipient of funds, EFT deposit to IRA owners Apple, Savings Checking NOW or Money, Specify Dollar Amounts, Specify affected retirement, and Please note that early withdrawals section will be applied to put down the rights or responsibilities of both parties.

2006 Federal Income Tax Withholding, Do not withhold federal income tax, I elect to have the amount of, Withhold federal income tax from, other percentage, payments not available for, Method of Payment, Automated Clearing House ACH Entry, Check mailed to the recipients, Check mailed to recipient of funds, EFT deposit to IRA owners Apple, Savings Checking NOW or Money, Specify Dollar  Amounts, Specify affected retirement, and Please note that early withdrawals fields to insert

Finalize by looking at all of these sections and completing the suitable data: FINANCIAL INSTITUTION NAME, RDFI Address, Routing TransitABA Number, AUTHORIZATION, By signing this authorization below, Account Number, Type of Account, Checking Account, Savings Account, You authorize us as Trustee to, You represent and warrant that the, and You acknowledge that withdrawals.

part 5 to finishing 2006

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